Gülbeyaz Can 1, İlknur Metin Akten 2, İlknur Yücel 3
1 Florence Nightingale Faculty of Nursing, Istanbul, Türkiye
2 Kırklareli University, Faculty of Health Sciences, Department of Nursing, Kırklareli, Türkiye
3 Istanbul Galata University, Vocational School, First and Emergency Aid Program, Istanbul, Türkiye
Received: 3 July 2024
Revised: 18 July 2024
Accepted: 18 July 2024
Published: 18 July 2024
Keywords:
COVID-19, ethical attitude, nursing care
Corresponding author:
İlknur Yücel
Istanbul Galata University, Vocational School, First and Emergency Aid Program, Istanbul, Türkiye. i.yucel084@gmail.com
doi: 10.5281/zenodo.12770668
Cite as:
Can G, Metin Akten İ, Yücel İ. The Relationship Between Ethical Attitudes And Care Behaviors in Nurses During the COVID-19 Process. Med J Eur. 2024;2(4):7-16. doi: 10.5281/zenodo.12770668
ABSTRACT
| It is of professional importance to ethically evaluate the care behaviors of nurses providing front-line healthcare during the COVID-19 virus epidemic. The aim of this study was to determine the relationship between nurses’ ethical attitudes and care behaviors during the COVID-19 pandemic. This descriptive and correlational study was carried out with 141 nurses at a university hospital. Data were collected with the Personal Information Form, Ethical Attitude Scale for Nursing Care and Caring Behaviors Scale-24. It was determined that there was a statistically significant difference in terms of the total scores of the Ethical Attitude Scale in Nursing Care according to the reasons why nurses found nursing care inadequate. (p = 0.008, p =0.031, p<0.001). It was determined that there was a positive, statistically significant relationship between the ages of the individuals participating in the study and the total scores of the Caring Behaviors Scale-24 (r = 0.185, p = 0.028). It was determined that there was a statistically significant difference in terms of total scores of Caring Behaviors Scale-24 according to the education levels of the participants (p<0.001). It was found that the ethical attitudes of the nurses participating in the study were at a good level and their perception of care behaviors was at a positive and moderate level. As nurses’ ethical attitudes increase, their perception of caring behaviors increases. |
INTRODUCTION / INTRODUÇÃO
The word “ethics” comes from the Greek “ethos”. Ethics is a concept that directs and makes sense of concepts such as good or bad, right or wrong, duty or obligation (1). The nursing profession is a health discipline that provides the protection, development and improvement of health and well-being in case of illness (2). The essence of nursing care stands out as a process carried out in a bilateral relationship between two individuals and based on mutual trust (3). Healthcare professionals should know how to act with attitudes and values towards events. Nurses should provide care based on the basic ethical principles of autonomy, benefit, justice and non-harm (2). Nurses should benefit from ethical principles while providing health care services to the patient. Nurses’ perception of care can be considered as what care means to nurses and how nurses interpret their attitudes, knowledge and experiences about care (3). Knowing nurses’ views on their perception of care and determining the differences between their views, if any, can contribute to the emergence of obstacles to providing effective care (4).
The COVID-19 virus, which is thought to originate from Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV), emerged in Wuhan, China in December 2019 and caused a global pandemic (5). Most of the individuals who are infected with the COVID-19 virus are treated at home by being socially isolated (5,6). COVID19 virus can cause disease symptomatically and asymptomatically (7,8). Throughout human history, different pandemic viruses have emerged, and problems such as quarantine restrictions in the management of infectious diseases by humans, restrictions on freedom of travel, obligations of health care providers to care for patients, and the public’s lack of information about the disease have revealed ethical problems (9). Many reasons such as the fact that the COVID-19 virus, which is seen today, has not been encountered before, it is not known how and where the disease will be transmitted, and the lack of protective equipment have caused healthcare workers to intervene in the virus and not be protected from the virus (9-13).
During the COVID-19 epidemic, it is of professional importance to evaluate the care behaviors of nurses who provide health services at the front line from an ethical point of view. Various epidemics have existed throughout human history and will continue to exist as long as humanity exists. The basis of the ethical problems seen in epidemics in history lies in the ignorance of the disease, being unprepared and not knowing how to intervene. It is important to recognize the pandemic danger in advance and to make appropriate planning. A limited number of studies on this subject have been found in the literature, but no study investigating the relationship between the scales used in this study has been found.
Aim
This study was conducted to determine the relationship between nurses’ ethical attitudes and care behaviors during the COVID-19 pandemic.
Research Questions
1. What are the caring behaviors and ethical attitude levels of nurses during the COVID-19 period?
2. What are the factors affecting the caring behavior and ethical attitude of nurses during the COVID-19 period?
3. Is there a relationship between ethical attitudes and care behaviors in nursing care during the COVID-19 period?
METHODS
Study Design
The research is cross-sectional and relationship-seeking. The research was carried out between March and December 2021 at an university hospital. The population of the study consisted of nurses working in the surgery and internal medicine clinics of the university hospital (N = 861). In the G*Power 3.1.9.7 program, the minimum sample size was calculated as 134 with α=0.05 and 95% power for correlation analysis based on an effect size of 0.30 (Faul et al., 2009). At the end of the research, 141 volunteer nurses were reached.
Data Collection Tools
The data was collected by the researcher through face-to-face interviews outside working hours. It took approximately 15-20 minutes to fill out the survey form. Survey Form was used as a data collection tool. Survey form; The Personal Information Form consists of three parts: Ethical Attitude Scale for Nursing Care (EASNC) and Care Behaviors Scale-24 (CBS-24).
Personal Information Form: This form was developed by the researchers in line with the literatüre. In this form, there are 9 questions that question the nurses’ socio-demographic characteristics such as age, gender, education level, working in the profession and the duration of working in the institution, the unit they work in and the duration of work. In addition, there are questions about COVID-19 such as “contagion status of COVID-19”, “if COVID-19 contagion, with whom did it come into contact”, “situation of exclusion due to profession during the pandemic process”, “opinion about whether nursing care is adequately provided to the patient”.
Ethical Attitude Scale for Nursing Care (EASNC): It was developed by Özçiftçi and Akın in 2020. It is a one-dimensional Likert-type scale consisting of 34 items and 5 points. The lowest score from the scale can be 34 and the highest score can be 170. An increase in the total score of the scale indicates positive ethical attitudes in nursing care, and a decrease indicates negative ethical attitudes in nursing care. Cronbach’s alpha value for the sum of the scale was 0.85 in nurses (2). In this study, it was determined that the internal consistency levels of the items that make up the scale were 0.83.
Caring Behaviors Scale-24 (CBS-24): Care Behavior Scale-24 (BDI-24), which was validated by Kurşun and Kanan in 2012, is a 6-point Likert type scale. The scale consists of 4 sub-dimensions and 24 items: Assurance (8 items), Knowledge-skill (5 items), Respect (6 items) and Commitment (5 items). As the total score of the scale increases, nurses’ level of perception of quality of care increases. In the validity and reliability study of the scale, the Cronbach’s alpha value for the total was determined to be 0.96 in nurses (14). In this study, the internal consistency level of the items forming the scale was calculated as 0.80.
Statistical analysis
R versus for statistical analyses. Program 2.15.3 (R Core Team, 2013) was used. Minimum, maximum, mean, standard deviation, median, first quarter, third quarter, frequency and percentage were used to report the study data. The conformity of the quantitative data to the normal distribution was evaluated by Shapiro-Wilk test and graphical analysis. Independent groups t-test was used to evaluate the normally distributed variables between the two groups. Kruskal-Wallis test and Dunn-Bonferroni post-hoc test were used for more than two group evaluations of variables that did not show normal distribution. Pearson correlation analysis was used to determine the level of relationship between quantitative variables. Cronbach’s alpha coefficient was used to determine the level of internal consistency. Statistical significance was accepted as p<0.05.
Ethical considerations
Prior to the study, ethics committee permission (Number: E-69456409-199-17535), Ministry of Health permission and institutional permission (Number: E-89969066-044-546056) were obtained. During the study, written and verbal voluntary consents of the participants participating in the study were obtained.
RESULTS
The findings regarding the socio-demographic characteristics of the nurses participating in the study were shown in Table 1. The ages of the nurses participating in the study ranged from 21 to 57 years, with an average age of 32.85±7.49 years. Of the participants, 80.1% (n=113) were female, 19.9% (n=28) were male, 17% (n=24) were high school, 75.2% (n=106) had an associate degree, 3.5% (n=5) had a bachelor’s degree, 4.3% (n=6) had a master’s degree, 51.8% (n=73) had a professional working period of 0-5 years, and 48.2% (n=68) had a professional working period of 5-10 years. 43.3% (n=61) of the participants worked in the institution between 0-5 years, 56.7% (n=80) between 5-10 years, 51.8% (n=73) in internal medicine and 48.2% (n=68) in surgical units. 43.3% (n=61) of the sample had a working period of 0-5 years, and 56.7% (n=80) had a working period of 5-10 years. Of the nurses participating in the study, 31.2% (n=44) worked during the day, 68.8% (n=97) worked at night, 36.2 (n=51) worked less than 40 hours a week, and 63.8% (n=90) worked 40 hours a week (Table 1). 72.3% (n=102) of the participants stated that they were infected with the COVID-19 virus. While 27.5% (n=28) of these participants were treated in the hospital, 72.5% (n=74) underwent social isolation at home. 53.9% (n=76) of the nurses stated that they encountered people with COVID-19 virus. Of these participants, 51.3% (n=39) stated that they encountered it in the hospital and 48.7% (n=37) in social areas. 30.5% (n=43) of the nurses stated that they cared for COVID-19 contacts, and 32.6% (n=46) stated that they were excluded due to their profession during the pandemic process. 30.5% (n=43) of the participants thought that the nursing care provided in the ward was sufficient. 5.7% (n=8) of the participants stated that the inability of nurses to work in the service they wanted, 5.7% (n=8) stated that the number of patients cared for daily was high, 22.7% (n=32) stated that the number of nurses working in the service was insufficient, and 66% (n=93) stated that the workload of the service other than patient care caused the lack of care (Table 1).
Table 1. Findings on Sociodemographic Characteristics of Nurses.
| Variables | Min-Max (Median) | |
| Age | 21-57 (33) | |
| n | % | |
| Gender | ||
| Woman | 113 | 80.1 |
| Male | 28 | 19.9 |
| Level of education | ||
| High school | 24 | 17.0 |
| Associate Degree | 106 | 75.2 |
| License | 5 | 3.5 |
| Master | 6 | 4.3 |
| Duration of professional work | ||
| Between 0-5 years | 73 | 51.8 |
| 5-10 years | 68 | 48.2 |
| Institution working time | ||
| Between 0-5 years | 61 | 43.3 |
| 5-10 years | 80 | 56.7 |
| Unit of Work | ||
| Internal medicine | 73 | 51.8 |
| Surgical units | 68 | 48.2 |
| Unit working time | ||
| Between 0-5 years | 61 | 43.3 |
| 5-10 years | 80 | 56.7 |
| How it works | ||
| Day | 44 | 31.2 |
| Night | 97 | 68.8 |
| Weekly working time | ||
| Less than 40 hours | 51 | 36.2 |
| 40 hours | 90 | 63.8 |
| COVID-19 contagion | ||
| Yes | 102 | 72.3 |
| No | 39 | 27.7 |
| If there is contamination, the place of treatment | ||
| Hospital | 28 | 27.5 |
| Social isolation at home | 74 | 72.5 |
| Contact with a COVID-19 person | ||
| Yes | 76 | 53.9 |
| No | 65 | 46.1 |
| Where is the contact, if any? | ||
| Hospital | 39 | 51.3 |
| Social area | 37 | 48.7 |
| Caring for a COVID-19 contact | ||
| Yes | 43 | 30.5 |
| No | 98 | 69.5 |
| Exclusion due to profession | ||
| Yes | 46 | 32.6 |
| No | 95 | 67.4 |
| Service maintenance competence | ||
| Yes | 43 | 30.5 |
| No | 98 | 69.5 |
| Reason for insufficiency | ||
| Nurses cannot work in the service they want | 8 | 5.7 |
| The high number of patients cared for daily | 8 | 5.7 |
| Insufficient number of nurses working in the ward | 32 | 22.7 |
| High workload of the service other than patient care | 93 | 66.0 |
In Table 2, the findings regarding the mean scores of the Ethical Attitude Scale for Nursing Care (EASNC) and the Care Behavior Scale-24 (CBS-24) are presented (Table 2). The mean score of the Ethical Attitude Scale for Nursing Care (EASNC) was found to be 84.04±13.01. Caring Behavior Scale-24 (CBS-24) general item score average is 2.79±0.39, Assurance, Knowledge-Skills, Respect and Commitment item mean score averages are 2.78±0.53, 2.84±0, respectively. 55, 2.75±0.48 and 2.82±0.42 were found (Table 2). The sociodemographic characteristics of the nurses participating in the study and the findings related to the total score of the Ethical Attitude Scale for Nursing Care (EASNC) and the Total Score of the Care Behaviors Scale-24 (CBS-24) were shown in Table 3. It was determined that there was a statistically significant difference in terms of the total scores of the participants according to the treatment processes after COVID-19 virus infection (p=0.008). Those who are treated in the hospital have lower scores. It was determined that there was a statistically significant difference in terms of the total scores of the EASNC according to the contact status of people with COVID-19 virus (p=0.031). Those who have come into contact with people with the COVID-19 virus have lower scores. It was determined that there was a statistically significant difference in terms of the total scores of the EASNC according to the reasons why the participants did not find the nursing care provided in the service sufficient (p<0.001). As a result of the post-hoc evaluations carried out using the Dunn-Bonferroni test, it was determined that the scores of the participants who thought that the reason for the inadequacy was “Excessive workload of the ward other than patient care” were higher than the scores of the participants who thought that “Nurses could not work in the service they wanted” and “The number of nurses working in the service was insufficient” (p<0.001, p<0.001, respectively). The age, gender, education level, working time in the profession, working time in the institution, units they work in, working hours, working styles, weekly working hours, transmission with the COVID-19 virus, where they come into contact with people with COVID-19 virus, care for the COVID-19 contacted individual, exclusion due to their profession during the pandemic process, finding the nursing care provided in the service sufficient, in terms of the total scores of the EASNC according to their situation There was no statistically significant difference (p>0.05) (Table 3).
Table 2. Findings on Mean Scores of the Ethical Attitude Scale for Nursing Care (EASNC) and the Care Behaviors Scale-24 (CBS-24).
| n | Min-Max (Median) | Mean±SD | |
| EASNC | 34 | 60-109 (87) | 84.04±13.01 |
| CBS-24– Assurance | 8 | 1.50-4.00 | 2.78±0.53 |
| CBS-24–Knowledge and Skills | 5 | 1.40-4.00 | 2.84±0.55 |
| CBS-24–Respectfulness | 6 | 1.67-4.00 | 2.75±0.48 |
| CBS-24 –Commitment | 5 | 2.00-3.60 | 2.82±0.42 |
| CBS-24 –Total | 24 | 1.71-3.92 | 2.79±0.39 |
SD: Standard deviation.
Table 3. Findings on Sociodemographic Characteristics of Nurses and Total Score of the Ethical Attitude Scale for Nursing Care (EASNC) and Total Score of Care Behaviors Scale-24 (CBS-24).
| EASNC | CBS-24 | ||
| Age | r | 0.030 | 0.185 |
| p | 0.727 | 0.028* | |
| Mean±SD | Mean±SD | ||
| Gender | |||
| Woman | 84.88±12.71 | 2.78±0.40 | |
| Male | 80.64±13.87 | 2.83±0.37 | |
| Test value (t) | 1.549 | -0.571 | |
| ap | 0.124 | 0.569 | |
| Level of education | |||
| High school | 86 (83, 95) | 2.56 (2.31, 2.81) | |
| Associate Degree | 87.5 (74, 92) | 2.79 (2.58, 3.08) | |
| License | 90 (78, 92) | 2.33 (2.21, 2.46) | |
| Master | 67.5 (66, 94) | 3.27 (3.08, 3.46) | |
| Test value (χ2) | 1.579 | 17.763 | |
| bp | 0.664 | <0.001* | |
| Duration of professional work | |||
| Between 0-5 years | 82.89±11.92 | 2.84±0.38 | |
| 5-10 years | 85.26±14.07 | 2.74±0.40 | |
| Test value (t) | -1.083 | 1.611 | |
| ap | 0.281 | 0.109 | |
| Institution working time | |||
| Between 0-5 years | 83.05±12.56 | 2.80±0.34 | |
| 5-10 years | 84.79±13.38 | 2.79±0.42 | |
| Test value (t) | -0.785 | 0.183 | |
| ap | 0.434 | 0.855 | |
| Unit | |||
| Internal medicine | 82.89±11.92 | 2.84±0.38 | |
| Surgical units | 85.26±14.07 | 2.74±0.40 | |
| Test value (t) | -1.083 | 1.611 | |
| ap | 0.281 | 0.109 | |
| Unit working time | |||
| Between 0-5 years | 83.05±12.56 | 2.80±0.34 | |
| 5-10 years | 84.79±13.38 | 2.79±0.42 | |
| Test value (t) | -0.785 | 0.183 | |
| ap | 0.434 | 0.855 | |
| How it works | |||
| Day | 83.34±11.31 | 2.73±0.37 | |
| Night | 84.35±13.76 | 2.82±0.40 | |
| Test value (t) | -0.458 | -1.291 | |
| ap | 0.648 | 0.199 | |
| Weekly working time | |||
| Less than 40 hours per week | 86.51±13.75 | 2.76±0.31 | |
| 40 hours per week | 82.63±12.44 | 2.81±0.43 | |
| Test value (t) | 1.711 | -0.783 | |
| ap | 0.089 | 0.435 | |
| COVID-19 contagion | |||
| Yes | 83.29±14.02 | 2.79±0.41 | |
| No | 85.97±9.80 | 2.79±0.35 | |
| Test value (t) | -1.279 | 0.049 | |
| ap | 0.204 | 0.961 | |
| Where treatment is underway | |||
| Hospital | 76.50±15.95 | 2.78±0.36 | |
| Social isolation at home | 85.86±12.38 | 2.79±0.42 | |
| Test value (t) | -2.803 | -0.097 | |
| ap | 0.008* | 0.923 | |
| C-19 person contact with the elephant | |||
| Yes | 81.91±14.77 | 2.77±0.39 | |
| No | 86.52±10.15 | 2.81±0.39 | |
| Test value (t) | -2.186 | -0.538 | |
| ap | 0.031* | 0.591 | |
| Contact | |||
| Hospital | 84.44±16.40 | 2.74±0.43 | |
| Social area | 79.24±12.50 | 2.80±0.35 | |
| Test value (t) | 1.557 | -0.680 | |
| ap | 0.124 | 0.499 | |
| Caregiving to a COVID-19 contact | |||
| Yes | 84.00±14.47 | 2.81±0.43 | |
| No | 84.05±12.40 | 2.78±0.37 | |
| Test value (t) | -0.021 | 0.343 | |
| ap | 0.983 | 0.732 | |
| Exclusion | |||
| Yes | 83.41±15.58 | 2.78±0.45 | |
| No | 84.34±11.65 | 2.79±0.36 | |
| Test value (t) | -0.357 | -0.140 | |
| ap | 0.722 | 0.889 | |
| Service maintenance competence | |||
| Yes | 84.00±14.47 | 2.81±0.43 | |
| No | 84.05±12.40 | 2.78±0.37 | |
| Test value (t) | -0.021 | 0.343 | |
| ap | 0.983 | 0.732 | |
| Reason for insufficiency | |||
| Nurses cannot work in the service they want | 67.5 (66, 70.5) | 2.9 (2.56, 3.1) | |
| The high number of patients cared for daily | 78 (78, 78) | 2.77 (2.54, 2.96) | |
| Insufficient number of nurses working in the ward | 82 (64, 88) | 2.77 (2.52, 2.92) | |
| High workload of the service other than patient care | 91 (79, 95) | 2.79 (2.5, 3.13) | |
| Test value (χ2) | 38.767 | 1.352 | |
| bp | <0.001* | 0.717 | |
r=Pearson correlation analysis, aIndependent groups t-test, In the Kruskal-Wallis test, results are presented as a median (first quarter, third quartile). *p<0.05. SD: Standard deviation.
It was found that there was a statistically significant positive correlation between the ages of the individuals participating in the study and the total scores of the Caring Behaviors Scale-24 (CBS-24) (r=0.185, p=0.028). It was found that there was a statistically significant difference in terms of CBS-24 total scores according to the education levels of the participants (p<0.001). As a result of the post-hoc evaluations using the Dunn-Bonferroni test, it was determined that the scores of the participants with a master’s degree were higher than the scores of the participants with a high school and undergraduate degree (p=0.005, p=0.012, respectively). It was determined that the scores of the associate degree graduates were higher than the scores of the high school graduates (p=0.029). According to the gender of the participants, the duration of work in the profession, the duration of work in the institution, the unit they work in, the working time in the unit, the way they work, the weekly working hours, the status of transmission with the COVID-19 virus, the duration of treatment after the COVID-19 virus infection, the contact with the people with the COVID-19 virus, the place where they come into contact with the COVID-19 virus, caring for the COVID-19 contact individual, exclusion due to their profession during the pandemic process, the nursing care provided in the service is sufficient There was no statistically significant difference in terms of total scores (p>0.05) (Table 3). The relationship between the total score of the Ethical Attitude Scale for Nursing Care (EASNC) and the scores of the Care Behavior Scale-24 (CBS-24) sub-dimensions and the total scores of the scale is given in Table 4. It was found that there was a statistically significant positive correlation between the total score of the EASNC and the CBS-24 Assurance (r=0.185, p=0.028) sub-dimension score. There was no statistically significant relationship between the total score of the Ethical Attitude Scale for Nursing Care (EASNC) and the Knowledge-Skills, Respectfulness, Commitment sub-dimension scores of the Care Behaviors Scale-24 (CBS-24) and the total score of the scale (p>0.05). It was found that there was a statistically significant positive correlation between the total score of CBS-24 and Assurance (r=0.881, p<0.001), Knowledge-Skill (r=0.858, p<0.001), Respectfulness (r=0.569, p<0.001), Commitment (r=0.770, p<0.001) sub-dimension scores. It was found that there was a statistically significant positive correlation between the CBS-24 Assurance sub-dimension score and the sub-dimension scores of Knowledge-Skill (r=0.841, p<0.001), Respectfulness (r=0.220, p=0.009), Commitment (r=0.503, p<0.001). It was determined that there was a statistically significant positive correlation between the CBS-24 Knowledge-Skill sub-dimension score and the Respectfulness (r=0.176, p=0.037) and Commitment (r=0.570, p<0.001) sub-dimension scores. It was found that there was a statistically significant positive correlation between the CBS-24 Respectfulness sub-dimension score and the Commitment (r=0.488, p<0.001) sub-dimension score (Table 4).
Table 4. The relationship between the total score of the Ethical Attitude Scale for Nursing Care (EASNC) and the scores of the Care Behaviors Scale-24 (CBS-24) sub-dimensions and the total scores.
r=Pearson correlation analysis, *p<0.05.
DISCUSSION
Nurses may encounter various ethical problems while performing their caregiving roles. Nurses must have ethical knowledge and attitudes to ensure patient well-being and safety by providing correct and reliable care (15). This study was conducted to determine the relationship between nurses’ ethical attitudes and care behaviors during the COVID-19 pandemic. The study found that nurses’ ethical attitudes in nursing care were at a good level. Accordingly, nurses show positive ethical attitudes during nursing care. The result of this study shows that nurses provide nursing care based on ethical principles. In a study (2023), intensive care nurses’ ethical attitude levels in nursing care were found to be high (16). In the study of Sezer et al. (2023), it was determined that pediatric nurses had positive ethical attitudes in nursing care (17). Gezginci et al. (2023) found that surgical nurses’ ethical attitude levels in nursing care were high (15). In the study conducted by Işık et al. (2022), it was reported that the ethical attitudes of intensive care nurses in nursing care were negative (18). Different results are found in the literature. It is thought that this result may be affected by nurses’ professional training on ethical issues, their working conditions and the units they work in. There was no statistically significant difference between the ages, education levels and length of time working in the profession of the individuals nurses in the study and the total scores of the EASNC (p>0.05). It was found that only those nurses who spent the treatment process in the hospital after contracting the COVID-19 virus and those who came into contact with people with COVID-19 virus had negative ethical attitudes in nursing care. In addition, it was determined that the nurses who stated that the most common reason for not finding the nursing care provided in the ward adequate was “the workload of the ward other than patient care” was high. It was determined that these nurses had high ethical attitudes in nursing care. A limited number of studies conducted during the COVID-19 period were found in the literature. Some studies have found that age and working time have effective on ethical attitudes (19-21). Similar to our study, Işık et al. (2022) found no relationship between the ages and ethical attitudes of nurses working in intensive care (18). Similar to our study, in some studies, no significant difference was found between the EASNC total scores and the educational level of the nurses participating in the study (19,21). Different from our study, in some studies, a statistically significant difference was found in terms of EASNC total scores as education level increased (20). Sezer et al. (2023) showed that the year of employment affects the ethical attitude of pediatric nurses, but age does not (17). Different results are found in the literature. Nurses’ ethical attitudes in nursing care may be affected by factors such as their working conditions, their access to protective equipment, the high risk of contamination to themselves and to those around them. In addition, it is thought that nurses’ strong individual values, professional education and professional philosophy are effective in their positive ethical attitudes in nursing care. The study found that nurses’ perception of caring behaviors was at a positive and moderate level. Dığın et al. (2022) study showed that surgical nurses’ perceptions of care quality were high (22). Erenoğlu et al. (2019) found in their study that the perceptions of nurses working in obstetrics and pediatrics units regarding care behaviors were at a high level in a positive direction (23). In a study (2018), it was shown that patients and nurses’ perceptions of nursing care quality were positive (24). Similar results are found in studies conducted. In our study, nurses’ positive moderate perception may be due to the fact that nurses have difficulty in fulfilling their roles and responsibilities regarding care due to the COVID-19 epidemic, and they think that they cannot properly reflect this on patient care. In our study, it was found that as nurses’ ages and education levels increased, their perception of caring behaviors increased positively. In some studies, it has been found that nurses’ age and education level do not affect their perception of caring behaviors (23,25). Different results are found in the literature. It is thought that the increase in education levels and the increase in experience as the age progresses may be effective in the positive increase in the perception of caring behaviors in nurses. It was found that there was a statistically significant positive correlation between the total score of the EASNC and the CBS-24 Assurance sub-dimension score. There was no statistically significant relationship between the total score of the Ethical Attitude Scale for Nursing Care (EASNC) and the Knowledge-Skills, Respectfulness, Commitment sub-dimension scores of the Care Behaviors Scale-24 (CBS-24) and the total score of the scale. In the literature review, no similar study investigating the relationship between both scales was found. Considering these results, it can be seen that this is the first study investigating the relationship between both scales. When the COVID-19 epidemic entered our lives, it negatively affected all our life behaviors. This study provides a significant advantage in raising awareness of this issue among nurses working in internal and surgical clinics during the epidemic period and makes a significant contribution to the literature. Therefore, it can be considered as the strength of the research. It was found that the ethical attitudes of the nurses participating in the study in nursing care were at a good level and their perception of care behaviors was at a positive and moderate level. It was determined that as nurses’ ages and education levels increased, their perception of caring behaviors increased. As nurses’ ethical attitudes increase, their perception of caring behaviors increases. Among the nurses participating in the study, those who had contact with people infected with COVID-19 virus and those who were treated in the hospital were found to have lower scores on the Nurses’ Ethical Attitude Scale in Nursing Care. In addition, it was determined that the were high the ethical attitudes of nurses, who stated that the service had a high workload other than patient care. It is recommended to determine the socio-demographic characteristics of nurses and provide in-service training before and after graduation, to explain the importance of ethical attitudes and care behaviors in nursing care in the institution where they work, and to conduct more comprehensive studies.
Study Limitations
The limitations of the study is that the research results can only be generalized to the group of nurses working in the hospital where the research was conducted.
Acknowledgement
The authors thank the participant for his/her support of the study.
Conflict of Interest
The authors declare no conflict of interest.
Author Contributions
Concept – İY,İMA,GC; Design – İY,İMA,GC; Supervision – İY,İMA,GC; Resources – İY,İMA,GC; Materials – İY,İMA,GC; Data Collection and/or Processing – İY,İMA,GC; Analysis and/or Interpretation – İY,İMA,GC; Literature Search – İY,İMA,GC; Writing Manuscript – İY,İMA,GC; Critical Review – İY,İMA,GC; Other – İY,İMA,GC
CC BY License
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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